small note , REM is not Speech mapping. Speech mapping was develop by audio scan using their own proprietary work. Kudos to the Coles, the other companies appropriate the term “speech mapping” -
While rem you try to match target, speech mapping you could tweak the instrument to maximize SII
fundamental difference
Where I am REM is a blanket term. Are you trying to differentiate between using speech as the stimulus versus tones (not just MPO)? No one uses that signal anymore.
An audiologist at a big practice in Kansas used REM to fit my existing aids. I had moved there from another state. She matched everything up and programmed my aids.
Terrible results.
Ultimately went back to the audiologist I use in Florida. He uses real world experience along with all of the high tech (including) REM. Much better.
REM is only a tool. The good audiologist is the key factor.
I appreciate your post.
I just want to hear. It’s taken almost two years and my hearing aids are finally setup.
I am going to sound really ignorant. I’m a HA wearer for almost 7 years. I’ve been to two different audiologists in two different states. Neither spoke about REM. Is this something the audiologists would discuss with me? I now have Oticon Real 1 HAs. I hate them. I am very interested in your thoughts.
This is not necessarily something that the HCP would discuss with their patients per se, even if they do it as a best practice. That’s because if they discuss it with you, they would have to take the time to explain to you the idea of what REM is, and not all patients will necessarily understand or care to understand it or need to understand it. So some HCPs just do it as part of their best practices and not say anything. Some might say something short and sweet like “I’m going to put some microphones into your ears to take some measurements and make adjustments if necessary, OK?” But they probably are not going to dive into the details of the whys and the how, etc.
Of course those HCPs who don’t include REM as a best practice in their fitting will most likely never bother bringing up a subject that they don’t do or elaborate without being asked why they don’t do it.
So even if you have an HCP that does REM for you, you may not be aware of it, unless you’re observant enough to remember noticing that they put something inside your ear canals before they had you put your hearing aids on so they could do something after that.
By the way, it’s OK to hate your hearing aids, but it’d be more helpful to explain why you hate them, especially if you want some feedback on whether your hate for them is justified or not.
And your provider needs to understand why you hate them to fix it. To help provide a structure for you, most people hate their hearing aids for one of, or a combination of, the following reasons: 1) Physical fit (discomfort), 2) Sound quality (discomfort), 3) Disappointment with benefit (whole bunch of reasons this can be the case). A lot can be done to improve at least the first two, and sometimes three.
Is this your actual REM experience? If you put in your hearing aids yourself after the HCP inserted the probe mic, how do you control where the mic ends up? You could smack it into your eardrum. And the something that happens afterward isn’t all that easy to miss, in my experience. They position a speaker next to your head and then play a series of not-so-harmonious tones/noises, while making adjustments on a keyboard.
The tube is soft. Some people hate being smacked in the ear drum but some people don’t notice.
Usually the clinician would place the hearing aid to ensure the mic stays in place, but I can see the benefits to having the patient do it themselves. Placement matters, and so if a patient regularly fails to insert the hearing aid all the way, then the gain isn’t going to be right while they are wearing it.
Hey, is that how yours were done? It’s not the way we’d do it here. Live Speech Mapping is as follows.
We fit the aids with the probe tubes (you can manage the depth with a v/o and the sliding marker). Then we start talking (checking the v/u meter) and observe the output. Then I’ll run a background noise track and repeat the speech at various orientations to the client: then modify the output of the aid and repeat.
If you use a garbled speech signal, if the hearing aid ‘thinks’ the input is speech, it’ll work (but only for unchallenged speech) so you don’t know how the aid performs in real world situations with speech. If the aid thinks it’s noise, it will turn down the output and you’ll end up overprescribing the aid in the real world.
If you use Real Ear Aided Response (with Live speech input) and map the output both with and without noise: 1 You make sure the aid sounds ok in quiet with speech and 2 You’ll find out how well the aid delivers speech in noise.
Unless you understand the difference between both paragraphs above AND can implement them under repeatable test conditions, you can’t derive much actual benefit from REM fittings - so all the ‘I fit to NAL2’ stuff you hear is basically rubbish unless you can prove the aid is going do the same thing in a real world setting.
Also: before anyone says they ‘do REM’ to a target using the in built REM mode on the hearing aid - I can probably find you a 2015 Diesel VW golf with 250,000 miles that ‘isn’t smoking at all’……
I just said the bold part above arbitrarily without any emphasis on exactly who should do it, the patient or the clinician. I don’t think it’s a big deal who does it because if the clinician lets the patient do it, they probably would observe to make sure that the patient does it properly to ensure that the probe mics don’t get misplaced. Regardless of who puts on the hearing aids, there is probably a reference point set up of some sort that the clinician can check to make sure that the probe mic is still in the same position afterward anyway.
Regarding whether one remembers what happens afterward, it may not be easy to miss for an observant or curious patient, but for a patient who doesn’t care to observe or has other things on their mind at the time, they may not know what it’s about and they can just lump it as the whole “testing” thing. Besides, it may not be the ONLY thing that could have gone on as part of the setup. Running the white noise generator to scan across the frequency range for feedback analysis is another thing that can put sound/noise into your hearing aids for testing. So is running some reference sound demo to see what the patient think about the volume level. For an uninformed patient, it would just be a “whole” experience of setting up the hearing aids for them and they wouldn’t know better which part is which.
So if you tell an unsuspecting patient that as long as they heard some sounds being produced during the setup, then that would imply that REM was done, that may incorrectly make them think so when it might not have been done at all, and it was just some of the other testing stuff that made the sounds.
and very thin and very flexible. Some may not be aware that there’s no mic on the end of the tube that’s inserted; it’s just an empty plastic tube that conveys sound from inside the ear canal to outside the ear canal to a mic there.
Garbled speech signal like the standard ISTS signal? What does “unchallenged” mean here?
Which is certainly a good baseline but might get the full attention of the aid if the AI doesn’t recognise it as speech. I’m using challenged in respect of worsening the SNR by introducing more noise via the background track.
That said, better to use it as a basis for accurate programming and then observe how the wearer finds the aids in speech and noise to refine the process.
You are incredibly helpful and knowledgeable. Thank you. My frustration over the last 7-8 months has kept my remark too short. I have been a HA wearer for 7 years. My first pair of Oticons never gave me one problem. I’ve been to two different audiologists in two different states and neither put anything in my ear.
I’ve been looking for assistance for months since neither the company nor my audiologist have solved the problems my HAs are causing. Actually this forum is the first one that has offered excellent advice and information. I have worn Octicon HAs for seven years. My first pair was issue free for 6 years. My audiologist recommended the newer version, Oticon Real 1. Since I’ve had them, I’ve had multiple problems. In fact after the first week, my audiologist and the company recommended that I send my new $4,500+ HAs back which I did. While some issues were fixed, I still have daily connectivity problems and in the middle of some days, they restart for no reason (without taking them off).
I’ve been told by many that it is my older iPhone and a new iPhone will solve the problem. With an investment of $4,500 already, another $700 is not in my budget. And those with newer iPhones also complain about the problems my HAs have caused. Buying a phone is not the solution.
I started researching the problems with Oticon Real 1. I am not alone. There are hundreds of complaints on line with problems similar to mine. My phone rings and I am unable to hear until I hit speaker. When I listen to podcasts or try to use my car speaker my HAs do not connect. My HAs spin on my phone and drain my phone battery. I re-pair, connect, my Oticons to my phone multiple times a day. This Never happened with my first pair ever.
I am on this community of HA wearers for four reasons:
I was brief in my post because I have written lengthy posts and answered so many questions without result. I’m pleased to see you noticed and cared. This HA community is the most knowlegable and kind group I’ve found in 7 months. Thank you for your input.
Susan
Thank you for your insightful post! It’s evident my experience with REM was destined to fail due to my HCP’s lack of this methodological understanding.
Your post underscores the importance of a competent HCP equipped with the best tools available. However, based on the many posts I’ve read here, your approach seems far from typical. How can HCPs achieve accurate fittings without these tools or frameworks? I don’t mean it as a rhetorical question; I’m just trying to assess how many out there are still selling old VW Golfs. 
. Can they achieve that without objective measurements?
Thanks for elaborating your issues with your Real. It sounds like your remaining unresolved issues mainly evolve around the connectivity between your Real and your iPhone, is that correct?
I won’t try to ask more probing question as you already said you had written lengthy posts and answered lots of questions already without any good results. Maybe I’ll just comment on a few points you make just in case whatever I say may help. If not, feel free to ignore.
Most of the connectivity issues I hear about on this forum on Oticon aids are mainly connectivity issues while using the aids with the ConnectClip, starting with the More, and then the Real. But Oticon seems to have resolved the issue with both → the Real first, then several months later with the More, via firmware updates. And the fix seems to have been confirmed to be good by folks on this forum.
If you don’t have and don’t use the ConnectClip, then of course none of your issues should relate to this. But one thing I would suggest is that if you have not done so already, ask your HCP to update your Real to the latest firmware. Not that I’d expect it to resolve your connectivity issues with your iPhone, but it’s simply a best practice to do so, and who knows? maybe you get lucky and whatever they did to fix the Real issue with the ConnectClip might have something to do with your iPhone connectivity issues as well. It doesn’t hurt to update to the latest firmware version on the Reals anyway.
The sudden restart on the aids for no reason is not that uncommon. When I initially had my OPN 1, this happened more often than not. After a number of firmware updates, this seems to alleviate. I’m suspecting that the sudden restart on your Real probably is linked to your connectivity issues between it and the iPhone. Again, firmware update to the latest version may or may not help, but at least if you know you have it done already, it’s another variable eliminated. The fact that your previous Oticon aids (which model did you have) were stable but the Real isn’t points to the fact the that Real is still relatively new and because of that, not as stable as your older Oticon model.
One workaround I may suggest, but not necessarily a permanent solution, is to ask your HCP to provide you with a ConnectClip (if you don’t already have one yourself), then try to establish your connectivity between the Real and the iPhone via the ConnectClip, instead of via the MFI. Of course this is not a desired permanent solution, but at least it’s a temporary workaround just to see if the Real has similar connectivity with the iPhone via classic BT through the ConnectClip or not. Just another data point to have.
Sudan, you are doing copy/paste to the same text all over, everywhere.
What’s th connection between the subject of this topic and your issue?
Please stop posting the same text all over.
I was talking about this:
All inside Genie
There is no need to run Genie and REM software in parallel. REM AutoFit communicates with the REM system to run the measurements. Genie can then automatically adjust the hearing aid gain to match the target, and gives you the flexibility to manually fine-tune and verify the fitting. This gives you a single software program to launch, work in, and maintain.
That does not mean that “Oticon has its own REM test inside the fitting software.” It means that Oticon’s fitting software can communicate with the REM hardware and software without the latter’s application software being separately opened by the fitter. But the REM hardware is required to use REM or REM AutoFit through Genie 2, which is Oticon’s fitting application.
Afterthought: REM requires insertion of a thin flexible tube into the ear canal along with the hearing aid, with the end of the tube being within ~5mm of the eardrum. The tube conveys the sound output of the hearing aid to a microphone outside the ear. The microphone in turn in electrically connected to the REM hardware. There is no provision in Genie 2 for accessing the signal from that microphone. The REM hardware compares the REM microphone’s signal to the fitting target and reports the result to Genie 2.